Key result
Blunted heart rate reserve during dipyridamole stress echo predicts ~86% higher mortality in INOCA patients.
Why the study?
Patients with INOCA may exhibit abnormal cardiac sympathetic function unmasked as reduced heart rate reserve during dipyridamole SE, but whether this predicts outcome remained to be assessed.
Does an abnormal heart rate reserve during dipyridamole stress echocardiography predict all-cause death in patients with INOCA?
Cohort (n=292)
Does an abnormal heart rate reserve during dipyridamole stress echocardiography predict all-cause death in patients with INOCA?
A blunted heart rate reserve during dipyridamole stress echocardiography is an independent predictor of long-term mortality in patients with INOCA, outperforming inducible ischemia.
Answers are grounded in this paper and cite their sources.
May support HRR for INOCA risk stratification during dipyridamole stress echocardiography; hypothesis-generating and requires prospective validation before practice change.
Background. Patients with ischemia and normal coronary arteries (INOCA) may show abnormal cardiac sympathetic function, which could be unmasked as a reduced heart rate reserve (HRR) during dipyridamole stress echocardiography (SE). Objectives. To assess whether HRR during dipyridamole SE predicts outcome. Methods. Dipyridamole SE was performed in 292 patients with INOCA. HRR was measured as peak/rest heart rate and considered abnormal when ≤1.22 (≤1.17 in presence of permanent atrial fibrillation). All-cause death was the only endpoint. Results. HRR during SE was normal in 183 (63%) and abnormal in 109 patients (37%). During a follow-up of 10.4 ± 5.5 years, 89 patients (30%) died. The 15-year mortality rate was 27% in patients with normal and 54% in those with abnormal HRR (p < 0.0001). In a multivariable analysis, a blunted HRR during SE was an independent predictor of outcome (hazard ratio 1.86, 95% confidence intervals 1.20–2.88; p = 0.006) outperforming inducible ischemia. Conclusions. A blunted HRR during dipyridamole SE predicts a worse survival in INOCA patients, independent of inducible ischemia.
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Cortigiani et al. (2021) conducted a cohort in Ischemia and normal coronary arteries (INOCA) (n=292). Abnormal heart rate reserve during dipyridamole stress echocardiography vs. Normal heart rate reserve was evaluated on All-cause death (HR 1.86, 95% CI 1.20-2.88, p=0.006). A blunted heart rate reserve during dipyridamole stress echocardiography independently predicted higher all-cause mortality in INOCA patients (HR 1.86; 95% CI 1.20-2.88; p=0.006).
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